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oclc - 02246644lccn - 74648956 issn - 0091-0031ocm02246644

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Related Items

Preceded by:

Weekly mortality index

Preceded by:

Weekly morbidity report

Succeeded by:

Morbidity and mortality weekly report

Full Text

NATIONAL COMMUNICABLE DISEASE

Vol. 18, No. 45

For

Week Ending

November 8, 1969

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE / PUBLIC HEALTH SERVICE 'HEALTH SERVICES AND MENTAL HEALTH ADMINISTRATION
DATE OF RELEASE: NOVEMBER 14, 1969 ATLANTA, GEORGIA 30333

EPIDEMIOLOGIC NOTES AND REPORTS
PLAGUE New Mexico

On No. 3, 1969, plague was confirmed in a 15-year-old
boy, a resident of Sandia Park, New Mexico, located about
10 mile- north of Albuquerque. On October 27, the boy had
onset of headache and abdominal pain, followed the next
day b. niu.ea, vomiting, and generalized arthralgia. On
October 29. he was hospitalized with chills, temperature
of 105 F.. and dehydration and was treated with intraven-
ous fluid-. The next day, he was first noted to have tender
erythemarou- swelling in his right groin and was treated
with ampicillin intravenously. By October 31, the mass in
the right groin was larger and a tender mass was noted in
the right lower quadrant which was associated with rebound
tendern_.- guarding, and hypoactive bowel sounds.
Because of a presumptive diagnosis of appendicitis
with abscess formation, the patient underwent exploratory

laparotomy. At oper t the appendix bowel
were normal, but the massive iliac addo y with
extensive inflammation. ecrosis. An Jbde was
excised and the wounds '
Microscopic examinati fttion of the
excised node showed inflammaa anges and gram-
negative bacteria. A presumptive diagnosis of plague was
made. Ampicillin was discontinued, and parenteral tetracy-
cline and streptomycin were begun. By November 1, the
patient was much improved.
(Continued on page 395)

Spring Quarter Epidemiologic Year 1968-69
In the United States during the spring quarter of epi-
demiologic year* 1968-69 (March 30, 1969 June 28, 1969),
I i,,i.- cases of viral hepatitis were reported for a rate of
6.5 cases per 100,000 population. This is a 5 percent in-
crease over the rate of 6.2 (12,225 cases) reported in the
spring quarter of epidemiologic year 1967-68 (Table 1). Six
of the nine geographic divisions had rate increases in 1969;
these ranged from 2 percent in the East North Central Divi-
sion to 126 percent in the New England Division. Massa-
chusetts and Rhode Island with rate increases of greater
than 100 percent accounted for the major part of the in-
crease in the New England Division. Other states which
also had rate increases of greater than 100 percent were
New Hampshire and Vermont in the New England Division,
South Dakota in the West North Central Division, South
Carolina in the South Atlantic D, .-,...o. and Nevada in the
Mountain Division.
Rate decreases were reported in theWestNorth Central,
West South Central, and Pacific Divisions. California, which
in previous quarters has shown increases in rate, experienced
a 16 percent decrease in rate compared with the previous
spring quarter.
Reported cases of serum hepatitis increased by 15
percent and cases of infectious hepatitis by 6 percent over
the previous spring quarter. All divisions experienced in-
creases in reported serum hepatitis cases except the Pacific
Division. which had a decrease, primarily reflecting the
large decrease in reported cases from California. Five of
the eight divisions with increases in reported serum hepatitis
cases had increases greater than 100 percent. The greatest
increase occurred in the Middle Atlantic Division, largely
due to increases from New York City and New Jersey.
Annual Summary Epidemiologic Year 1968-69
Data for epidemiologic years 1967-68 and 1968-69 are
presented in Table 2 and Figure 1. A total of 52,587 cases
of viral hepatitis were reported in EY 1968-69. The number
of reported cases of viral hepatitis per 100.000 population
for the United States increased from 22.3 cases in 1967-68
to 26.2 in 1968-69. This overall increase in rate for the
United States incorporates rate increases from seven geo-
graphic divisions and rate decreases from two divisions
(\est North Central and West South Central). Four geo-
graphic divisions (New England. Middle Atlantic, Mountain,
and Pacific)experienced increases in rate greater than that
for the United States as a whole. The largest increase in
rate (14.4) occurred in the New England Division where
reported viral hepatitis cases for 1968-69 increased by
1,674 cases (94.6 percent) over 1967-68. The West South
Central Division recorded the largest decrease in rate (2.1).
Figure 2 depicts the cyclic variation in incidence of
reported viral hepatitis cases in the United States by 4-
week periods since July 1952. The progressive increase in
annual incidence observed since epidemiologic year 1967
continued through epidemiologic year 1969.
lHepatitis data are summarized in terms of an epidemiologicc
year" beginning with the 27th week of the calendar year.

Figure 1
NUMBER OF REPORTED CASES OF VIRAL HEPATITIS PER 100,000 POPULATION BY STATE
EPIDEMIOLOGIC YEARS 1967-68 AND 1968-69

S'6 1968-1969 .,

.- *I

PLAGUE (Continued from front page)
Gram-negative bipolar staining organisms were isolated mains well. The epidemiologic investigation is continuing.
from three blood cultures obtained early in the hospitaliza- (Reported by Bruce Storrs, M.D., Director, Division of
tion. These were submitted to the state laboratory, where Medical Services, Daniel Johnson, Ph.D., the Public Health
on November 3 they were confirmed as Pasteurella pestis Laboratory, and Bryan Miller, Chief, and Neil Weber, Mam-
by phage typing and guinea pig inoculation. malogist, General Sanitation Section, New Mexico State
The boy had no known contact with wild animals, but Department of Public Health; U. Hodgin, M.D., David Post,
did have contact with three family cats, one dog, and several M.D., and Ole Peloso, M.D., Physicians, Albuquerque; and
horses, all of which remain well. The boy's family also re- an EIS Officer.)

*Mortality data are being collected from Las Vegas, Nev., for possible inclusion in this
Las Vegas, Nev.* 19 8 1 table, however, for statistical reasons, these data will be listed only and not included in
Sthe total, expected number, or cumulative total, until 5 years of data are collected.

Morbidity and Mortality Weekly Report

INTERNATIONAL NOTES
INFLUENZA Summer and Fall 1969'

The epidemic of A2 Hong Kong influenza, which was
first recognized in July 196b in Hong Kong and which then
spread rapidly I.r,.l, l ,i Southeast Asia, to the United
States. and to Europe during the fall and winter of 1968,
diminished in late spring 1969 in most areas of the world.
.\lri.ii'Al little or no activity was reported in the northern
hemisphere after that, smoldering activity continued in the
southern hemisphere. In South America, Uruguay reported
widespread epidemic activity during June 1969 with school
and industrial absenteeism reaching 50 and 20 percent, re-
spectively: schools were closed on June 18 for the rest of
the month duc to influenza. Chile reported influenza-like
disease of epidemic proportions in Santiago and the central
provinces with the peak occurring during the third week of
July and the epidemic waning by mid-August. Strains from
both Uruguay and Chile as well as strains isolated in
Argentina during the same period were confirmed as closely
related to A2/ H.iri Kong/68 by the World Health Organiza-
tion International Influenza Center for the Americas.
Thailand. which also reported influenza A2 activity
in late summer 1968, had an increase in .,1 I; ;. beginning
in mid-September 1969. Recently isolated strains were
closely related to A2 Hong Kong/68.
Sporadic cases of a mild influenza-like disease con-
firmed by virus isolation, have been reported from Senegal
since April 1969. with epidemic levels being reached in
August and September.
During September and October, an increase in influenza-
like illness was noted in Hawaii, and a number of cases
were confirmed by serology and by isolation of a Hong
Kong-like virus.
In Australia, influenza activity was first reported in
the northern provinces in late summer 1968, and epidemics
were reported in Melbourne and .' Jrr*, in August 1969;
marked diminution in severity had been noted by the end
of the month. New Zealand reported A2 influenza activity
:ir..Ijlbr.,r the summer with a decrease by mid-September
1969.
At present, an epidemic of major proportions is occur-
ring in remote areas of the Papua-New Guinea highlands.
A large number of cases have been reported with an esti-
mated I .'11, deaths as of October 22. Pneumococcal pneu-
monia has been a major complication. An A2/Hong Kong-
like virus was isolated at the International Influenza Center
for the Americas from the throat washings of several pa-
tients in New Guinea. Australian army and territorial
personnel are participating in evaluation of the epidemic.
(Reported by Dr. Anthony Morris and Dr. Carlton Gajdusek,
Division of Biologics Standards, National Institutes of
Health; the World Health Organmizatioun International In-
fluenaa Center for the Americas, Atlanta, Georgia; and the
Kr.spiralory Diseases Unit, Viral Diseases Section, Epi-
demiology Proyrami, Ni')C.)

THE MORBIDITY AND MORTALITY WEEKLY REPORT. WITH A CIRCULAR'
TION OF 18,500 IS PUBLISHED AT THE NATIONAL COMMUNICABLE
DISEASE CENTER, ATLANTA, GEORGIA.
DIRECTOR, NATIONAL COMMUNICABLE DISEASE CENTER
DAVID J. SE'I ER M D
DIRECTOR. EPIDEMIOLOGY PROGRAM A. D. LAtli.Mu. M D.
EDITOR MICHAEL B. GRtIG M D.
EDITOR pro tam ALAN R. ,.IMAN M D.
MANAGING EDITOR PRISCILLA B. HOLMAN
IN ADDITION TO THE ESTABLISHED PROCEDURES FOR REPORTING
MORBIDITY AND MORTALITY. THE NATIONAL COMMUNICABLE D'SE SE
CENTER WELCOMES ACCOUNTS OF INTERESTING OUTBREAKS OR CA SE
INVESTIGATIONS WHICH ARE OF CURRENT INTEREST T0 HEALTH
OFFICIALS AND WHICH ARE DIRECTLY RELATED TO THE CONTROL
OF COMMUNICABLE DISEASES. SUCH COMMUNICATIONS S.OUL.D BE
ADDRESSED TO:
NATIONAL COMMUNICABLE DISEASE CENTER
ATTN: THE EDITOR
MORBIDITY AND MORTALITY WEEKLY REPORT
ATLANTA, GEORGIA 30333

NOTE: THE DATA IN THIS REPORT ARE PROVISIONAL AND ARE
BASED ON WEEKLY TELEGRAMS TO THE NCOC BY THE INDIVIDUAL
STATE HEALTH DEPARTMENTS. THE REPORTING WEEK CONCLUDES
AT CLOSE OF BUSINESS ON FRIDAY; COMPILED DATA ON A NATIONAL
BASIS ARE OFFICIALLY RELEASED TO THE PUBLIC ON THE SuCCEED-
ING FRIDAY.